Arch Planning Healthcare Exchange 1556909

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Iterative Approach to Build an Enterprise

Architecture for Health Insurance Exchange
Maharshi Desai, Director, IT Strategy and Enterprise Architecture
maharshi.desai@oracle.com
Oracle Enterprise Architecture
Oracle Enterprise Architecture
Copyright 2012 Oracle Corporation. All rights reserved.
Agenda
Objectives
Enterprise Architecture Methodology and Framework
Applying Principles and Methodology to HIX
What is Health Insurance Exchange?
Plan and approach
Artifacts
Summary

Objectives
Understand how to apply iterative methodology to build
Enterprise Architecture
Understand the Oracle Enterprise Architecture Framework
and Oracle Architecture Development Process
Use case on how to apply iterative approach to build
exchanges like Health Insurance (HIX)
Read more on our approach in this posted white paper
http://www.oracle.com/technetwork/topics/entarch/oea-niem-ia-513961.pdf

Methodology and Framework

Oracle EA Guiding Principles
Agility and Sustainability
Forward Thinking
Business Driven
Time to Value
Best Practices
Oracle Architecture Development Process
Practical Approach,
Proven Methodology
Aligns with customer
and industry standard
EA frameworks
Iterative
Agile EA Approach
Reuses best practice
business models and
reference architectures
Provides
Governance
Oracle Enterprise Architecture Framework
Best Practices,
Proven EA Artifacts
Best Practice Reference Architectures
Reduces Architecture/Solution
Development Time
Applying Iterative Approach to Build
A Health Insurance Exchange

Health Insurance Exchange Background
The Patient Protection and Affordable Care Act was
passed on March 23, 2010. The law requires states to
participate in 1 of 3 options:
Establish and operate a state-run exchange
Partake in a regional exchange (multi-state)
Federally-administered exchange
States must have infrastructure operational by Jan 1, 2014
A Health Insurance Exchange (HIX) A central marketplace
for citizens to compare:
Rates, Benefits, Quality of Care
Health Insurance Exchange Background
Exchanges will help:
Individuals/families with incomes between 133-400%
of the federal poverty line (2010)
Up to $43K for an individual; $88k for a family of four
Cap on premiums and out-of-pocket spending
Small businesses (up to 100 employees)
Small Business Health Options Program (SHOP)
About four million small businesses could qualify
Total of $40 billion in relief for small firms over the next 10 years
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Employers Individuals
Web Phone, IVR Email Text Chat Local Office
Eligibility Automation Portal Layer (Customer, Worker, Provider)
MMIS
Systems
De-duplication
Standardization
Matching
Services
Master Data Management
& Data Quality Services
Fraud Detection
Client Index
Address
Cleansing
Providers Workers
Web
Phone,
Fax, IVR
Email,
Imaging
Text Chat
Local
Office
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Enrollment
Billing
Plans / Pricing
Issuers
AHBE Access
Health Insurance Exchange Portal
Mobile /
Disconnected
SOA Enterprise Integration Services
IRS
DHS
SSA HHS
DMV
Equifax
Authoritative
Data
CHIP
OSHASP
Medicaid
Data Management
Structured &
Unstructured Data
Data Security &
Availability
Health Insurance Exchange Functions
Eligibility &
Enrollment

Policy Automation
Eligibility
Determination
Subsidy/Premium
Calculation
Enrollment
Plan
Management

E-Commerce/Catalog
Carrier Portal
Plan Certification
Renewal
Customer
Services

Contact Center
Self-Service
Carrier / Employer /
Broker Support
Account Management
Financial
Management

Billing
Collection
Premium
Reconciliation
Payment
Communications

Marketing/Outreach
Notices
Escalations
Oversight

Mandatory
Reporting
Dashboards & Alerts
Metrics / KPI
SHOP Access Content
Other Self-Service
Tools
Online
Applications
Eligibility
Screening
Calculators
Request
Service
Profile
Management
HIX Vision Architecture

Architecture Blueprint Plan
Business
Architecture
Business Application Architecture
Business Information Architecture
Apps/Data Technology Architecture
Establish
Architecture
Vision
Roadmap
Planning
90-120 Day Plan
Key Development Principles
Rapid Iterative Design (3 Week cycles)
Map Business to Functional Technology Design
Collaborative Design with Stakeholders
Leverage Oracle Reference Architectures
Approach: Level 0 and Level 1 Boundaries
Business
Architecture
Application
Architecture
Data
Architecture
Technology
Architecture
Define the core Business
Capabilities
Identify high level Application
Services required to support
the Business Capabilities
Identify high level Information
Models, Data organization,
and Data governance
Identify high level
Technology Platforms
required to support the
Business Capabilities
Application Diagrams
Application Capability Models
Application tech. Support
Models
Data Object Models
Data Integration Diagrams
Data Context
Technology Capabilities
Technology Support Models
Business Capability Models
Business Process Models
Business Process Support
Models
Oracle Enterprise
Architecture
Framework Layers
Level 0 (L0) Level 1 (L1)
Approach: Level 1 and Level 2 Boundaries
Business
Architecture
Application
Architecture
Data
Architecture
Technology
Architecture
Application Diagrams
Application Capability
Models
Application tech. Support
Models
Data Object Models
Data Integration Diagrams
Data Context
Technology Capabilities
Technology Support
Models
Business Capability Models
Business Process Models
Business Process Support
Models
Level 1 (L1)
Presentation Components
Business Logic Components
Business Data Objects
Integration Services
Data Services
Security Services
1 Model for each App.
Service
Technology Detail Models
Detail Integration Diagram High
level Canonical Models,
Technology, and Systems
Level 2 (L2)
Next level Entity Models
Data Formats
Data Standards
Data Governance and Security
For each high level
Entity
For each interface
At the entity level
only
Oracle Enterprise
Architecture
Framework Layers
Business Architecture Approach
Business Requirements
Eligibility & Enrollment (E&E)
E&E - Individual
Prepare / Update Individual Eligibility
Application
Accept and Verify Application for
Completeness and Accuracy
Manual Verification
1 Business Area
1.1 Business Process Group
1.1.1Business Process
1.1.1.1 Business Activity
1.1.1.1.1 Business Tasks
Use Cases
Business Strategy & Value
Business Process to Service Mapping
Services
Business
Service
Application
Service
Objects
Business
Objects
Application
Objects
1.1.1.1 Business Activity
Architecture Execution Plan
Project startup
activities
July 2011 August 2011 Sep 2011 Oct 2011 Nov 2011
Plan Management
L1
EE Individual
L1
EE - SHOP Employer
L1
EE SHOP Employee
L1
Plan Management
L3
Design
Review
Plan Management
L1-L2
3 Week Cycle
EE Individual
L1-L2
EE - SHOP Employer
L1-L2
EE SHOP Employee
L1-L2

Detailed Design Document
EE Individual
L3
Dec 2011
EE - SHOP Employer
L3
EE SHOP Employee
L3
Financial Management
L1
L1-L2
3 Week Cycle
L3
Running Workshop
Level 1
Level 2
60 Minute session
(3 Days/Week):
Business Analysts
Process SME
IT Team (Optional)
90 Minute session to
review Application
Component, UI
Component, Data
Component and
Business Objects:
Business Analysts
(Optional)
IT Team (Data & Apps)
Level 3 & 4
90 Minute JAD session:
Business Analysts
IT/Development Team
Business
Process Flow
&
Requirements
Review
Refine
Business
Application
Data
Technology
Architecture
Level 1
Level 2
Federal
Requirements
State
Requirements
Requirement
Baseline
Architecture Models
Level 1 and Level 2
Use Cases
Architecture Models
Level 3 and Level 4
JAD Session
Finalize
Product Vision
Iterative
Development
Product Demo and Acceptance
Connecting Blueprint Phase to
Development Phase
Business Architecture
Highlights the key architecture capabilities and their alignment
Highlights alignment in greater detail for each business process
Highlights alignment of Business Services to Application Services
Application Architecture
Highlights how each business services are map to apps services
Highlights how each apps services are map to UI component and BOs
Data Architecture
Highlights application data object mapping of business data objects
Define overall ERD diagram
Highlights in-a-glance identified HIX data integration touch points
Highlights overall view of how data is supported in its associated context
Technology Architecture
Highlights the required HIX Technology Capabilities
Highlights the focused technology capabilities of a specific component
Map to products required to support the specific capabilities
HIX Logical Architecture
Logical Architecture provides component view of HIX Solution
HIX Technical Architecture
Solution Architecture provides overall physical view of the architecture
Summary
Develop a top down business-driven architecture
Design in agility and sustainability
Use an Agile/Iterative EA approach
Just-enough, just-in-time method
Oracle uses an open and practical process and framework
for architecture development
Oracle Enterprise Architecture Framework (Link)
Oracle Architecture Development Process (Link)

Join the Oracle EA Community
Oracle.com/goto/EA
Oracle.com/goto/ITStrategies
Twitter
twitter.com/OracleEAs
Facebook
facebook.com/OracleEA
LinkedIn
Oracle Enterprise Architects A Public Discussion Forum
Oracles EA Blog
blogs.oracle.com/EnterpriseArchitecture

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Iterative Approach to Build an Enterprise

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